Permit A ♦ as CITY OF TIGARD PLUMBING PERMIT
100014 DEVELOPMENT SERVICES DATE ISSUED: 7/18/02
Ai' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: PLM2002 -00281
SITE ADDRESS: 11777 SW QUEEN ELIZABETH ST PARCEL: 2S110CD -00113
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of water heater
FEES
Owner:
Type By Date Amount Receipt
KING CITY RESIDENTIAL PRMT BB 7/18/02 $72.50 KING CITY
CENTER, LTD 5PCT BB 7/18/02 $5.80 KING CITY
BY LARRY DRAPER
LAKE OSWEGO, OR 97035 Total • $78.30
Phone 1:
Contractor:
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone 1: 632 -7374 Rough -in Insp
Reg #: LIC 81746 Final Inspection
PLM 3 -359PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: 4 � � f.C , l/i;J Permittee Signature: hi, P�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busine da
07/15/2002 10:29 5036393771 CITY OF KING CITY PAGE 02/02
X002
y - Building Fixtures
Plumbing Permit Application orrim: -F i_E 0\1\
c. c of Tigard �- - u i.. i i ail Date received: Permit no.. P o .. . .
r of ngmd Address: 13125 SW HallEbf ,g Ellk9 2 311 fi"""r attain ea.:
Phone: (503) 639.4171
Pax: 003) 5911 -1960 /00Z 9 I 111 Date Issued: • '
By:
Land use approval: Case file no.:
•
TA PL OF PER•tiil
0 1 & 2 family dwelling or accessory OCommenclal/industial
Q New Coauruction Addition/alteration/ ulti- family 0 Tenant improvement
J"r replaCetnent ❑ Food service 0 atber
JOR SITE 1 \bURMa lli)ti I"EE SCHEDULE Itol specintii ttjrmationusechccklki)
Job address: 1 1 7 77 ac,l 4 . . M DeseW !V
aaFee(aL.) Total •
Bldg. no.: Suite no.: New 1- and 2.. walling, ,,,
Tax ma . lax lodaeeouat no.:
(Include, WO R. far each utility cam ion)
Lot Block S SFR (I) bath
Project name: SFR ) bath
S . 3 bath •
City /county: C. 2IP: a L '/ Each a • ditional bath/kitchen
D , • ti • don and t • atio • of work on • remises: ' Site utilities: '
•
• • e. oa I. Catch basin/area drain
E , . date of co . ! non/inspection: Drywel IS11eAOh line/trench drain
N.EJ ini NG' Cts \ - Tft CTuR
wring dram m. fin. ft)
Business name: Manufactured Ea= utilities
Address: /So Manholes
C �� ' Raip drain eammectar
Ciry: Ore
• State: ZIP: 9.7DV5' Sanitary sewer no. lie. ft.
]'hone: S 3'63 E-mail: corm sewer no. fin ft.
CCS no.: 8I ?AA, Plumb. bus, rag. no: 3.3 76 ' atar service no. tin, - —
City /metro lie. no.: 5.75/2 lFu
V cturnorirean
Contractor'8 _ ve signature L Abs .'on valve
Print name: Date: C4-- Back flow • enter
:
CONTACT P1•_RSOti' mins
aans / lavatory
Name: Clothes washer
Address: Dishwasher
Drinkin ounce' • s)
ZW' Ejectors /sump
Phone: Fax: E -mail:
gXDansiap tank tank .
ntt.INT It Fixture/sewer rap
Name (print): F oar drains /floor sinks/hub .
Mailing address: Garbage disposal
City: State; ZIP: floes bibb
Phone: Ice maker
Fax: E -mail: Interceptor/grease trap
Owner installariothesidential maintenance only The actual installation Prinaer(s) -
will be made by me or the maintenance and repair made by my regular Roo • • • in (commercial) V
employee on efts property I own as per ORS Chapter 447. _
•
Owner's s' y . tare: . Date; Sump basin(s).
ENC IN FE i hi/shower/shower pan .
Name: Uri
Name: Water closet
City Water heater 1 . • . . O
� 2IP: ether.
Phone: Fax: E -mail: Total
Nom as iueimasies .amp ,m,di mr4 p..e sensation for mate III Minim= Etc ...... �........ S ,., • s0 • QV tvot This yem appli review (al _ °/i) S
im.e� Rawl m w� / within 160 days after if a permit is not obtained S tate Plan r eview (8%) ) S ;j $J
LnR it hoe been ) —
- NUM at wow*. Y rbbW* M weal ..o1 accepted as complete-
TOTAL S _ - 7$- 7$0
1daci ► aaa AIe0Mown r
�J ,,
wa-wa6 01004C0bn
•
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVI Business Line: (503) 639 -4171 MST
(--1/ BUP
Received Date Requested AM PM BUP
Location 1 7 7 7 „ .._� /AA ..... e MEC
Contact Person P ( ) PLM
a
Contractor Ph ( ) 3 a- - '13 7 if SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling t%
Other:
Final fiZ2- - __
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan �l/
I ) . t-\
.61-
PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date I nspector � Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL